‘How are you feeling?’

Postnatal depression (PND) is a common problem, affecting around
one in 10 new mothers in the year following the birth of a child.
Yet despite its potentially lifelong consequences for the child, it
frequently goes undetected and untreated.

Some mothers suffering postnatal depression have very good
relationships with their babies. But the agitation and distress the
mother experiences tend to make her less sensitively tuned to her
baby’s experience and more preoccupied with her own. And it
seems that it is the mother’s reduced sensitivity to the
baby, and in some instances a tendency to be more critical and less
affectionate than non-depressed mothers, which affects the
baby’s development.

Heather Welford, writer for the National Childbirth Trust on
PND, says: “Babies need human contact and socialisation to learn
and develop. Postnatal depression interferes with mothers’
ability to communicate with their baby. They find it much more
difficult to look at their babies, talk to them and give them space
to come back to them.”

For some families, the onset of postnatal depression can be the
trigger for a chain of adverse events. The depressive episode
affects the child’s early development and the mother’s
relationship with the child, which in turn puts pressure on the
whole family. Even a short episode of depression can cause lasting

Research carried out in Cambridge by Professor Lynne Murray from
Reading University1 shows that
children, especially boys, of mothers who have been depressed in
their first year, perform less well in cognitive tests at 19
months, and are more likely to be rated by teachers in their first
year at school to have behavioural problems.

However, Murray points out that children living in favourable
circumstances often recover from their initial disadvantage. She
says: “Cambridge was quite a low risk population. It doesn’t
have the social problems of inner London where another study found
lasting cognitive effects in boys. It is poverty and social
problems and factors in the child – prematurity or illness after
birth – coupled with postnatal depression that pose the risk.”

Murray goes on: “What seems to happen is that the mother finds
it difficult to respond positively to the child. Even when she
stops being depressed she sustains a negative attitude.” But she
stresses there is nothing inevitable about PND leading to lasting
problems in the child, because so much can be done. “It
doesn’t mean that you can’t break out of the negative
cycle. Even in the most at-risk groups only a minority of children
develop problems.”

Alarmingly, a high proportion of postnatal depression goes
undetected. As many as two in five cases are not picked up by
health visitors, unless they have been specifically trained.
Particularly in areas where there are high vacancy rates, women may
have little or no contact with a health visitor beyond the first
few weeks after the birth. At the baby’s six-week and
nine-month developmental checks a mother may be asked just a single
question about how she is feeling.

A depressed woman may not realise she is ill or may be reluctant
to disclose it because of the stigma associated with mental

However, PND can be reliably detected with the aid of the
Edinburgh postnatal depression scale (EPDS) when used by staff with
specialist training. Kath Broscombe, a health visitor working in
Barkerend Sure Start in Bradford finds the questionnaire helpful.
She says: “It’s only an indicator and needs to be used by
someone trained to look for other signs of depression. But
it’s a useful way of introducing a discussion with a woman to
find out how she is feeling.”

Once the illness has been diagnosed, there are several
interventions which can be effective. Murray has published a book1
containing stills from videos of mothers interacting with their
babies which can be used to help women communicate with their
babies. The effectiveness of individual counselling by a specially
trained health visitor over a period of a couple of months is also
well validated by research. Group therapy can also be very
beneficial for women who are socially isolated.

Many women find antidepressants helpful, particularly if their
depression is moderate to severe. According to Welford, some GPs
incorrectly tell mothers they should stop breastfeeding when taking
medication. “There’s a lot of poor practice,” she says.
“Women can be treated with antidepressants while they are
breastfeeding. For some women, breastfeeding is one thing that they
feel they are doing well.”

The Barkerend programme runs a variety of interventions,
including support groups and one-to-one visiting, and encourages
women to take part in activities like postnatal massage. Broscombe
says: “Baby massage is very useful. It’s a five-week
programme of contact with the mother and baby. It helps with
bonding as well as giving you time to develop a one-to-one
relationship with a woman.”

Despite examples of good practice, many women with PND still
receive no professional support. Breige Coyle, lead professional
officer at the Community Practitioners and Health Visitors
Association (CPHVA) for PND acknowledges that services are patchy.
She says that since the publication of the National Service
Framework for Mental Health three years ago requiring health
authorities to develop protocols for early identification and
treatment of PND there has been a “flurry of activity to get
something in place”. However, it is difficult to tell how far this
is leading to better services.

Coyle adds: “Postnatal depression is being given more priority
than in the past. But an awful lot more needs to be done. There
needs to be more training and more multidisciplinary working. In
many parts of the country services aren’t adequate because of
a lack of staff.”

1 L Murray, The Social Baby, Understanding
Babies’ Communication, The Children’s Project, 2000

‘In Punjabi there is no word for

At the moment there is no diagnostic tool for women with little
knowledge of English. Barkerend Sure Start, Bradford, is working
with Sheffield University to validate a questionnaire in Punjabi
based on the EPDS developed by Razia Bhatti-Ali for detecting
depression in Asian women. Bradford health visitor Kath Broscombe
is optimistic that it will help women who find it particularly
difficult to talk about their experience. She explains: “There are
women in any community who are reluctant to express how they are
feeling. Having a baby is supposed to be a joyous time. In Punjabi
there is no word for depression. Women who have arrived recently
find it odd that someone should ask them how they are feeling. But
we find they are grateful that people are asking them these

What does postnatal depression feel like?

“For the first few weeks I was doing really well, feeding the
baby, looking after my older children, running the home. Then, when
he was about seven weeks old, I started to feel that I wasn’t
coping. I’d start crying when I was changing or dressing him.
I was convinced that I was unfit to be his mother and that I was
going to harm him. I felt that I couldn’t cope with the older
ones. They seemed completely out of control.

“I was sleeping badly – sometimes I’d just get off to
sleep and then wake up almost immediately and stay awake all night
with my heart pounding and my mind racing. I had this awful feeling
of agitation and couldn’t concentrate properly. I went to see
my GP who prescribed anti-depressants. I didn’t take them
because I was worried about them getting into the milk. He referred
me for some counselling but the waiting list was for over a

“I couldn’t talk about it to my friends – one said it was
a shame I wasn’t enjoying my children, and that made me feel
even more of a failure. My nerves were raw and I couldn’t
stand the older ones quarrelling. Then I’d end up shouting at
everyone myself, or just crying. Sometimes I thought it would be
better for them if I put them all into care. I felt like I was in

A mother of four in her mid-thirties

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